Cervicogenic Headache: Cause and Treatment

Cervicogenic Headache: Cause and Treatment

Everyone gets a headache from time to time, sometimes caused by fatigue, stress, illness or trauma. But chronic headache that persists over time should not be ignored. It can indicate structural or mechanical issues that can lead to more serious symptoms down the road.

Cervicogenic headache does not originate in the head, but rather in the third occipital nerve that runs between the second and third cervical vertebra. It is a common site for trauma related injury like whiplash, where the neck hinges forward and back with excessive force, causing inflammation and putting pressure on the nerve.

Cervicogenic headache may also be caused by weak muscles, poor posture and harmful habits like excessive texting, which forces the head forward from the center of the shoulders, increasing its relative weight by two to four times, and placing stress on the neck (a condition called Text Neck). Forward head posture places strain on the muscles, ligaments, discs and joints of your neck, causing inflammation and irritating the nerves in your neck and head.

Characteristics of Cervicogenic Headache

A cervicogenic headache differs from a migraine or cluster headache in that it does not involve nausea or sensitivity to light and sound. Some of the symptoms of cervicogenic headache include:

  • One-sided head or facial pain
  • Pain in the back of the head, temples or behind the eyes that stays in one spot
  • Headache pain that remains moderate to severe
  • Pain that lasts from hours to days
  • Deep pain without throbbing
  • Pain triggered by neck movement, coughing, sneezing, texting or other movements that place pressure on the neck
  • Stiff neck with limited range of motion

Treatment for Cervicogenic Headache

There are a few simple strategies that may help relieve cervicogenic headache pain:

  • Apply ice to the upper neck and take NSAIDs to reduce inflammation
  • Refrain from activities that force your head forward from your shoulders, like texting
  • Make a conscious effort to sit erect with good posture when driving, watching TV, reading or working on the computer
  • Stay away from activities that put excessive stress on your neck, like headstands and some yoga postures
  • Engage in a regular balanced exercise program that promotes good spinal alignment and strengthens the muscles that support your head and neck

Chiropractic adjustments and physical therapy may also help alleviate cervicogenic headaches and reduce damage and inflammation in the area around the third occipital nerve.

Research at NYDNRehab

About the Author

Dr. Lev Kalika is clinical director of NYDNRehab, located in Manhattan. Lev Kalika is the author of multiple medical publications and research, and an international expert in the field of rehabilitative sonography, ultrasound guided dry needling and sports medicine Dr. Kalika works with athletes, runners, dancers and mainstream clients to relieve pain, rehabilitate injuries, enhance performance and minimize the risk of injuries. His clinic features some of the most technologically advanced equipment in the world, rarely found in a private clinic.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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